title: Evaluating national practice of preoperative radiotherapy for rectal cancer based on clinical auditing.
abstract: OBJECTIVE
  Internationally, the use of preoperative radiotherapy (RT) for rectal cancer varies largely, related to different decision-making based on the harm-benefit ratio. In the Dutch guideline, RT is indicated in all cT2-4 tumours. We aimed to evaluate the use of RT in the Netherlands and to discuss Dutch practice in the context of current literature.
  
  
  METHODS
  Data of the Dutch Surgical Colorectal Audit (DSCA) were used and 6784 patients surgically treated for primary rectal cancer in 2009-2011 were included. The application and type of RT were described according to age, comorbidity, tumour localization and tumour stage at population level with analysis of hospital variation for specific subsets.
  
  
  RESULTS
  In total, 85% of patients who underwent resection for rectal cancer received RT. Comorbidity (Charlson Comorbidity Index 2+) and older age (≥70 years) were associated with a slight decrease in application of RT (75 and 80% respectively). In stage I tumours, 77% of patients received RT, but large hospital variation existed (0-100%). The proportion chemoradiotherapy of the whole group of RT increased with increasing N-stage, increasing T-stage, decreasing distance from the anus, younger age and less comorbidity with hospital variation from 0 to 73%.
  
  
  CONCLUSIONS
  From a European perspective, a high percentage of rectal cancer patients are treated with RT in the Netherlands. Considerable hospital variation was observed for RT in stage I and the proportion of chemoradiotherapy among all RT schemes. Data from clinical auditing enable evaluation of national practice and current standards from both a scientific and international perspective.
authors.affiliation: Leiden University Medical Centre, Department of Surgery, K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: nvanleersum@gmail.com.
authors.forename: N J
authors.initials: NJ
authors.lastname: van Leersum
authors.forename: H S
authors.initials: HS
authors.lastname: Snijders
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: D
authors.initials: D
authors.lastname: Henneman
authors.forename: C A M
authors.initials: CA
authors.lastname: Marijnen
authors.forename: H R
authors.initials: HR
authors.lastname: Rutten
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: P J
authors.initials: PJ
authors.lastname: Tanis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009426:Netherlands; D017410:Practice Guidelines as Topic; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D055815:Young Adult
keywords: Benchmarking; Clinical audit; Colorectal neoplasms; Colorectal surgery; Guideline adherence; Radiotherapy